Physician Specialty and the Quality of Medical Care Experiences in the Context of the Taiwan National Health Insurance System

Jenna Tsai; Leiyu Shi; Wei-Lung Yu; Li-Mei Hung; Lydie A. Lebrun

doi:10.3122/jabfm.2010.03.090222

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Table 1.

Quality of Medical Care Experiences among Patients Seen by Primary Care Physicians Versus Specialists (Total Sample = 646)

	Primary Care				Specialty Care					Significance^*
	PC (Sample Range: 261–281)	Internal Medicine (Sample Range: 82–90)	Family Medicine (Sample Range: 93–95)	Pediatrics (Sample Range: 86–96)	SC (Sample Range: 261–281)	OBGyn (Sample Range: 79–88)	Gastroenterology (Sample Range: 91–94)	General Surgery (Sample Range: 85–91)	Dermatology (Sample Range: 86–92)	t Test	ANOVA
First contact (utilization)	2.94 (0.73)	2.91 (0.69)	2.85 (0.74)	3.05 (0.76)	2.69 (1.00)	2.43 (0.92)	2.95 (1.38)	2.67 (0.71)	2.69 (0.78)	3.53^§	5.18^§
First contact (access)	2.55 (0.72)	2.61 (0.72)	2.61 (0.68)	2.44 (0.75)	2.16 (0.74)	2.11 (0.87)	2.17 (0.69)	2.19 (0.66)	2.18 (0.76)	6.73^§	8.20^§
Ongoing care	2.66 (0.75)	2.66 (0.77)	2.62 (0.65)	2.70 (0.84)	2.48 (0.73)	2.30 (0.87)	2.55 (0.67)	2.54 (0.68)	2.54 (0.67)	2.95^‡	2.70^†
Coordination (referral)	2.72 (0.65)	2.67 (0.64)	2.69 (0.63)	2.80 (0.69)	2.58 (0.69)	2.35 (0.83)	2.77 (0.66)	2.49 (0.57)	2.68 (0.60)	2.62^‡	5.17^§
Coordination information system	2.70 (1.16)	2.55 (0.74)	2.87 (1.68)	2.66 (0.76)	2.52 (0.76)	2.39 (0.83)	2.63 (0.72)	2.43 (0.74)	2.60 (0.74)	2.43^‡	2.62^†
Comprehensiveness (services available)	2.62 (0.76)	2.54 (0.71)	2.58 (0.70)	2.73 (0.85)	2.40 (0.83)	2.48 (0.91)	2.46 (0.76)	2.19 (0.75)	2.46 (0.86)	3.47^§	3.84^§
Comprehensiveness (Services provided)	2.78 (0.73)	2.65 (0.71)	2.81 (0.62)	2.88 (0.84)	2.57 (0.72)	2.35 (0.89)	2.55 (0.71)	2.65 (0.63)	2.72 (0.58)	3.60^§	5.29^§
Family centeredness	2.77 (0.76)	2.67 (0.77)	2.68 (0.68)	2.97 (0.79)	2.56 (0.80)	2.41 (0.89)	2.59 (0.71)	2.51 (0.80)	2.73 (0.77)	3.38^§	4.84^§
Community orientation	2.28 (0.64)	2.26 (0.65)	2.24 (0.66)	2.33 (0.61)	2.00 (0.73)	2.00 (0.78)	2.19 (0.73)	1.89 (0.63)	1.94 (0.74)	5.06^§	6.08^§
Cultural competence	2.65 (0.66)	2.75 (0.69)	2.65 (0.64)	2.55 (0.66)	2.46 (0.73)	2.21 (0.79)	2.61 (0.63)	2.29 (0.78)	2.69 (0.61)	3.39^§	7.99^§
Overall PC experience	26.60 (5.32)	26.21 (5.66)	26.57 (5.10)	27.00 (5.25)	24.41 (5.65)	23.01 (7.38)	25.49 (5.08)	23.90 (4.90)	25.07 (4.75)	4.81^§	5.85^§

For each area of PC and SC listed, both minimum and maximum sample sizes are provided. Statistics included in the table are mean scores (SD) for the domains of health care experiences.
* t test compares PC with SC. ANOVA compares differences across specialties.
† P < .05.
‡ P < .01.
§ P < .001.
PC, primary care; SC, specialty care; OBGyn, obstetrics/gynecology; ANOVA, analysis of variance.

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Table 2.

Quality of Overall Medical Care Experiences among Patients by Physician Specialty and Patient Sociodemographic Characteristics

Characteristics	Primary Care Areas								Specialty Care Areas
	Primary Care		Internal Medicine		Family Medicine		Pediatrics		Specialty Care		Obstetrics/Gynecology		Gastroenterology		General Surgery		Dermatology
	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n	Mean (SD)	n
Sex
Male	26.47 (5.93)	63	27.38 (4.86)	30	25.79 (6.60)	27	25.01 (7.88)	6	24.44 (4.91)	127			24.58 (5.27)	38	24.28 (4.69)	48	24.50 (4.93)	41
Female	26.69 (4.97)	188	26.08 (5.63)	47	26.89 (4.35)	66	26.90 (5.09)	75	24.61 (5.91)	207			26.16 (4.93)	52	23.35 (5.25)	36	25.59 (4.58)	45
Age (years)	F = 3.76^*
<18	26.98 (5.00)	78		2	26.24 (2.83)				26.97 (2.03)	6			28.31 (1.37)	3			25.37 (2.35)	2
18–44	25.82 (5.49)	128	25.85 (5.73)	60	25.80 (5.31)	68			24.36 (5.65)	224	23.38 (7.26)	66	26.34 (4.36)	47	22.83 (4.39)	49	25.11 (4.94)	62
45–64	29.22 (4.16)	29	28.97 (4.06)	16	29.51 (4.41)	13			25.09 (4.98)	85	28.19 (1.61)	4	24.25 (5.98)	38	25.15 (4.28)	25	25.65 (3.85)	18
≥65	28.54 (5.94)	5	26.01 (9.88)	2	30.23 (3.34)	3			24.85 (6.91)	15			22.57 (0.49)	2	26.50 (7.22)	10	20.86 (7.53)	3
Education	F = 3.34*
<High school	27.24 (5.39)	34	27.89 (8.67)	9	28.20 (3.46)	9	26.32 (3.96)	16	25.19 (5.28)	66	24.29 (4.77)	2	23.75 (4.97)	20	23.87 (5.32)	32	25.74 (2.42)	12
High school	27.91 (4.01)	61	27.41 (3.37)	14	27.65 (4.03)	18	28.31 (4.37)	29	24.68 (5.07)	90	25.23 (4.57)	13	25.20 (5.22)	23	24.59 (4.31)	25	24.77 (4.37)	29
Some college	25.41 (5.70)	104	25.25 (5.74)	38	25.79 (5.12)	41	25.01 (6.68)	25	25.47 (5.44)	102	24.73 (5.38)	25	25.94 (5.49)	36	21.61 (4.03)	17	25.22 (5.42)	24
≥College	26.99 (5.42)	48	27.09 (4.82)	16	26.98 (6.18)	22	26.85 (5.08)	10	25.23 (5.31)	67	23.80 (7.11)	31	27.70 (2.76)	11	25.86 (5.44)	8	25.19 (5.05)	17
Employment
Full time	26.50 (5.61)	125	25.74 (6.13)	29	27.41 (5.63)	46	26.09 (5.27)	50	24.55 (5.15)	164	24.97 (5.79)	24	23.62 (5.44)	46	22.73 (4.38)	45	25.01 (4.90)	49
Part time	27.37 (4.29)	21	28.30 (4.20)	7	26.92 (3.11)	10	26.87 (7.45)	4	23.03 (5.25)	39	21.65 (7.40)	9	24.15 (5.27)	15	22.53 (3.11)	6	22.90 (4.13)	9
Unemployed	27.84 (5.60)	39	26.95 (6.93)	11	25.79 (5.93)	12	29.99 (3.57)	16	25.09 (5.97)	84	23.74 (7.66)	27	25.99 (4.27)	20	25.54 (6.10)	21	25.68 (4.20)	16
Retired, in school, or other	25.91 (4.78)	63	26.40 (5.15)	30	25.60 (3.78)	24	25.08 (6.15)	9	25.38 (5.70)	40	23.89 (7.66)	11	25.68 (5.64)	8	25.93 (3.85)	9	26.12 (5.24)	12
Household income (New Taiwan $)					F = 3.39*
<650,000	27.01 (4.75)	46	28.14 (5.18)	7	25.42 (4.45)	23	28.80 (4.47)	16	23.13 (5.95)	74	20.05 (7.04)	25	24.51 (7.57)	13	23.81 (2.22)	17	25.63 (3.66)	19
650,000–849,000	28.01 (5.40)	52	27.74 (5.73)	24	29.12 (3.74)	18	26.64 (7.07)	10	24.43 (5.41)	90	25.38 (5.59)	13	23.38 (5.53)	20	23.53 (5.13)	31	25.84 (5.46)	26
≥850,000	26.95 (5.64)	33	25.49 (5.51)	13	28.39 (6.39)	14	26.75 (3.58)	6	22.81 (5.85)	38	19.10 (9.58)	8	23.26 (2.35)	5	22.38 (3.52)	6	24.39 (4.60)	19
Health status									F = 6.59^‡		F = 7.88^‡		F = 4.41^†		F = 3.81^†
Excellent	26.57 (6.02)	21	24.96 (7.95)	9	29.01 (3.38)	6	26.55 (4.53)	6	25.35 (3.89)	20	23.88 (5.68)	7	28.59 (1.22)	3	25.79 (2.54)	4	25.14 (2.17)	6
Very good	26.50 (4.96)	87	25.63 (4.68)	23	26.64 (4.99)	33	27.01 (5.20)	31	25.69 (5.59)	69	26.21 (4.74)	13	27.39 (4.02)	23	25.47 (5.82)	9	23.87 (6.85)	24
Good	26.62 (5.12)	70	26.93 (5.10)	25	26.43 (5.65)	26	26.49 (4.62)	19	25.99 (4.25)	94	26.46 (4.73)	26	26.27 (3.81)	19	24.43 (5.71)	13	26.06 (3.50)	36
Fair	26.52 (5.88)	76	26.35 (6.61)	22	25.87 (5.03)	27	27.31 (6.19)	27	22.75 (5.94)	144	18.85 (8.31)	33	24.87 (4.73)	35	23.02 (4.25)	57	24.79 (4.18)	19
Poor	26.85 (4.07)	3	28.46 (4.18)	2			23.62 (3.38)	1	22.88 (9.05)	11			19.85 (8.08)	8	34.83 (1.94)	2	23.24 (3.28)	1
Physical/mental problems
Yes	28.23 (5.23)	26	26.05 (1.15)	3	28.22 (6.26)	16	29.19 (3.82)	7	26.79 (3.94)	33	28.53 (3.98)	6	26.61 (2.91)	13	27.74 (4.90)	8	24.17 (4.03)	6
No	26.70 (5.24)	192	26.22 (6.08)	68	26.55 (4.81)	63	27.40 (4.60)	61	25.33 (5.01)	227	25.28 (5.36)	51	26.83 (4.55)	51	24.10 (4.82)	52	25.21 (5.02)	73
Additional private insurance	F = 15.55^‡		F = 8.70^†		F = 9.17^†								F = 4.91*
Yes	28.61 (4.27)	80	28.43 (4.15)	30	28.58 (3.69)	31	28.93 (5.41)	19	26.11 (4.95)	97	28.29 (5.57)	14	28.32 (2.79)	27	24.99 (5.32)	35	23.69 (4.58)	21
No	25.33 (5.97)	75	23.45 (7.74)	20	25.26 (4.45)	24	26.61 (5.55)	31	25.07 (3.99)	129	25.91 (3.33)	30	25.92 (4.92)	28	23.65 (4.18)	36	25.13 (3.15)	35

Mean (SD) statistics are for the overall quality of primary care experiences. Analysis of variance compares differences across categories of patient characteristics.
* P < .05.
† P < .01.
‡ P < .001.

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Table 3.

Effect of Primary Care Versus Specialty Care on Quality of Medical Care Experiences: Results of Multiple Regressions

	Model 1^* (Unadjusted)		Model 2^† (Adjusted)
	Standardized Coefficients (SE)	tScore	Standardized Coefficients (SE)	tScore
Overall primary care experience	0.23 (1.61)	5.82^‡	0.14 (1.75)	3.19^§
First contact (utilization)	0.14 (0.21)	3.53^‡	0.08 (0.25)	1.64
First contact (access)	0.26 (0.23)	6.73^‡	0.25 (0.26)	5.85^‡
Ongoing care	0.12 (0.24)	2.95^§	0.05 (0.27)	1.21
Coordination (referrals)	0.07 (0.23)	1.87	0.00 (0.27)	−0.09
Coordination (information systems)	0.10 (0.23)	2.43^‖	0.09 (0.28)	1.85
Comprehensiveness (services available)	0.14 (0.19)	3.43^‡	0.08 (0.22)	1.77
Comprehensiveness (services provided)	0.32 (0.36)	8.37^‡	0.09 (0.37)	2.33^‖
Family centeredness	0.13 (0.19)	3.38^‡	0.04 (0.22)	0.97
Community orientation	0.19 (0.17)	4.98^‡	0.15 (0.19)	3.34^‡
Cultural competence	0.13 (0.17)	3.39^‡	0.16 (0.20)	3.45^‡

In this table, the reference group is specialty care.
* The independent variable in model 1 is physician specialty (primary care vs specialty care).
† In model 2, independent variables included patients’ sex, age, education, employment, household income, health status, physical/mental health problem, and additional private health insurance in addition to physician specialty.
‡ P < .001.
§ P < .01.
‖ P < .05.